Physician Compare National (NPI:1043252075)

HEALTHCARE PROVIDER: DALE R GRAY M.D.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1043252075
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	9830155977
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20041209000570
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	GRAY
	Individual professional last name
Provider First Name	DALE
	Individual professional first name
Provider Middle Name	R
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.
Provider Credential Text	MD
	The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.

Medical School Information
Medical School Name	UNIVERSITY OF ILLINOIS COLLEGE OF MED (CHI/PEOR/ROCK/CHM-URB)
	Individual professional's medical school
Graduation Year	1982
	Individual professional's medical school graduation year
Primary Specialty	INTERNAL MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	2720 GLENWOOD CT
	Group Practice or individual's line 1 address
City	ROCKFORD
	Group Practice or individual's city
State	IL
	Group Practice or individual's state
Zip Code	611013507
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	140239
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	ROCKFORD MEMORIAL HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	140228
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	SWEDISH AMERICAN HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	140233
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	OSF SAINT ANTHONY MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	Y